Provider Demographics
NPI:1164686606
Name:FINE, MATTHEW SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:SAMUEL
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1951 SW 172ND AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33029-5593
Practice Address - Country:US
Practice Address - Phone:786-563-3463
Practice Address - Fax:888-972-5618
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2016-05-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 109795208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006336000Medicaid
FL9661865OtherAETNA
FLP01731847OtherSIMPLY HEALTHCARE
FLP1002647OtherFREEDOM HEALTH
FL356310OtherAVMED
FLP01074807OtherRAILROAD MEDICARE
FLPRV0002504OtherPREFERRED MEDICAL PLAN
FLQMP000003993334OtherMOLINA HEALTH
FL1193037OtherWELLCARE
FL67679OtherUNIVERSAL HEALTHCARE
FLP0014373OtherFLORIDA HEALTHCARE PLUS
FL1096098OtherCAREPLUS/NEW CENTURY
FL14L81OtherBCBS FL
FL9560391OtherCIGNA
FL1043332OtherJMH HEALTH
FL26024OtherMEDICA
FLF00347690601OtherUNITED HEALTHCARE
FLP943155OtherOPTIMUM
FLP01731847OtherSIMPLY HEALTHCARE
FLGH788YMedicare PIN